UTILIZATIONMANAGEMENTFORADULTMEMBERS Quarters1&2:January-June2015 ExecutiveSummary&AnalysisbyLevelofCare. Submited: September1,2015

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1 UTILIZATIONMANAGEMENTFORADULTMEMBERS Quarters&:January-June ExecutiveSummary&AnalysisbyLevelofCare Submited: September,

2 Authors: RobertW.Plant AnnPhelan LynneRinger ElizabethFeder LindsayBetzendahl Acknowledgements: TheauthorswouldliketoacknowledgetheimportantcontributionsoftheQualityAnalystTeam leadbyjoseph Bernardi(RebeccaNeal,IvanTheobolds,JohnBroadwel,KatePowers,StephanieShorey-Roca,ShwetaTiwari, andmelissawiliams)andthereportinganalystteam leadbyrayroccheti(susandonavon,mikebaron,sarah Brdar,WalyFarel,Jim Greer,LonnieMadeux,andBilOwen).

3 UTILIZATIONREPORTFORADULTMEMBERS Quarters&:January-June GeneralOverview Thisisthefirstreporttoreflectchangesinthetimingandformatoftheutilizationreview.First,thesereportswilnowcovertwoquartersandbecompletedsemiannualy.Thereviewofthedatawilcontinuetolookatquarters;theunderlyingreportsandgraphswilnotcombinethetwoquartersinto6-monthfigures.Second, theformatwilchangetotableau,amoreinteractivedatavisualizationproduct. Onatleastasemiannualbasis,thereportsmutualyagreeduponinExhibitEoftheCTBHPcontractaresubmitedtotheStateforreview.Thisreportfocuseson theutilizationmanagementportionofthesereports,evidencedinthe4aserieswhichreviewsutilizationstatisticssuchasadmissionsper,members(admits/,),daysper,members(days/,),andaveragelengthofstay(). Asstatedinprevioussubmissions,resultsweregraphedonlyforbenefitgroupsthathadasuficientvolumeofmembersreceivingservicesineachlevelofcare (LOC).Theutilizationreportfocusesonlyonthoselevelsofcareinwhichthedatawarantedanalysisanddiscussionasevidencedbysignificantchangesand trendsorincaseswhenchangesandtrendsareunclearandadditionaldataisneeded.asaresult,thisreportoutlines/highlightstheareasofinterestrelatedto certainutilizationtrends,aswelastheunderlyingfactorswhichdrivethetrendandassociatedprogrammaticresponsestakenbybeaconhealthoptionstoimpact/mitigateorsupportthetrend.wealsopresentrecommendationstoaddressremainingchalengesandreportprogressrelatedtotheseplannedrecommendations.theareasoffocusforthisquarterarelistedonthefolowingpage. ReportsUsed CTBH63AL_Utilization_Statistics_(4A_)_XRV CTBH63AS_Utilization_Statistics_(4A_)_XRV CTBH63FS_Utilization_Statistics_(4A_)_XRV CTBH63HB_Utilization_Statistics_(4A_)_XRV CTBH63LS_Utilization_Statistics_(4A_)_XRV CTBH63ML_Utilization_Statistics_(4A_)_XRV CTBH63AD_Utilization_Statistics_(4A_)_XRV CTBH63FD_Utilization_Statistics_(4A_)_XRV CTBH63LD_Utilization_Statistics_(4A_)_XRV CTBH63ALD_Utilization_Statistics_(4A_)_XRV *Notethatbenefitgroupswithlessthanadmitsareexcluded from graphing.dualeligiblemembersarealsoexcluded.vertical graylinerepresentsthemostrecentlyrefreshedquarter. SignificanceTesting Statisticalsignificancetestingwasconductedfor thesemeasures.however,asaresultofthelarge populationsizes,relativelysmaldiferencescan flagaparticularmeasureasstatisticalysignificant withoutbeingclinicalymeaningful.forthepurposesofthisreport,onlythosemeasuresthatare bothstatisticalysignificantandclinicalymeaningfulwilbediscussedandnotedasstatisticalysignificant(seepageforfulresults). Methodology Theshifttosemiannualreportswasdesignedtominimizenoisecreatedbyquarter-to-quarterfluctuationsthat donotreflectatruetrendinthedata.however,asagreed,thesesemiannualreportswilcontinuetoinclude quarterlyleveldetailratherthanasimplerol-upofsixmonthperiods.thisachievesthebalanceofmaking surethatsignificantandmeaningfulquarterlyfluctuationsarenotmissedwhilemaintainingafocusonmore persistenttrends.thedatacontainedinthisreportarebasedonauthorizationadmissionsandarerefreshed foreachsubsequentsetofupdatesduringtheyear.duetoandchangesineligibility,theresultsforeach quartermaychangefrom thepreviously-reportedvalues.thereportsandanalysesforallevelsofcareare afectedbythischange.therefore,thegraphicalpresentationsofthedatauseaverticallinetodesignatea particularquarterasthemostrecentquarterthatincludesrefresheddata.pleasenotethatutilizationmetrics maychangewiththerefreshofthedata.therefore,thereadershouldbecautiouswheninterpretingthelatest quarterofdata.thecontractorwilmonitorthepost-refreshchangesclosely.ifwaranted,themethodology wilberevisited. Themethodologyformembershiptotalsremainsunchanged.FortheTotalMembershipcounts,eachmember isonlycountedonceperquarter,evenifhe/shechangeseligibilitygroupsorexperiencesgapsineligibility. Forinstance,ifamemberchangesbenefitgroupswithinaquarter,thatmemberisincludedinthetotalsfor eachbenefitgroup,butonlyonceforthetotalmembership.thismethodologyisreferedtointhegraphsas "uniquemembership. Asof 3,dualeligiblemembers,includingHUSKYAdualandHUSKYCdual,wereremovedfrom al membershipandutilizationindicatorswiththeexceptionofhomehealthandmentalhealthgrouphomemeasures.foralotherlevelsofcare,indicatorswerereportedwithouttheduals.however,wewilcontinueto presentatotalmembershiptablethatincludesthedualyeligibleandamembershiptablethatexcludesthe dualyeligible,forcomparisonpurposes.

4 UTILIZATIONMANAGEMENTFORADULTMEMBERS Quarters&:January-June ExecutiveSummary&AnalysisbyLevelofCare Submited:September, TableofContents SelectMicroscopetoView"AreasofFocus" AndGoDirectlytoSelectedPage AreasofFocus Membership InpatientFacilities: AverageLengthofStay InpatientDetoxification Hospital-Based: AverageLengthofStay InpatientDetoxification Freestanding: AverageLengthofStay HomeHealthServices: MedicationAdministrationFrequency UtilizationRates Forthisreport,thefolowingutilizationdatapointshavebeen placedintheappendixandarenotdiscussed: MentalHealthGroupHome,&AverageLengthofStay PartialHospitalizationProgram IntensiveOutpatient AmbulatoryDetox MethadoneMaintenance OutpatientServices

5 AdultMedicaidMembership TotalMembershipVolume PG TotalUniqueMembership Grayverticallineindicatesthelastrefreshedquarter NoteAboutChangetoMethodology RegardingDualyEligibleMembers: (Hoverovericon): Membership 8K 6K 4K TotalMembership Thetotalmembershipforadultscontinuestoincreaseforbothand AlBenefitswithDuals.Historicaly,priortothe datarefresh,thereappearedtobeadecrease inmembershipinthemostrecentquarterthat doesnotholdtrueoncethedataisrefreshedin thefolowingquarter.therefore,itisfulyexpectedthatthe'numberswilincrease abovethe'levelatthenextreportingperiod. K K (Adult) AlBenefitsWithDuals(Adult) TotalMembership(IncYouth) ACAImplementation Membership CountMethodology Q3 Q4 DataRefresh SincetheimplementationoftheAfordableCare Actin 4,theimpactofthedatarefreshhad returnedtoamorehistoricallevel,indicating thatprocessingefortshavecaughtupwiththe newmembershipcohort.however,thedatarefreshratein peakedonceagainatarate of.3%.thisisexpectedtobeanannualimpactofopenenrolment. BenefitGroup (Adult) 3,8 37,74 39,36 33,99 386,49 4,4 4, ,987 4,7 449,3 SelecttoView RefreshRate Graph AlBenefitsWithDuals (Adult) 397,78 4,8 44,768 47,93 463,78 48,6 497,448 4,73 3,368,84 TotalMembership(Inc Youth) 696,4 7,786 76,64 7,89 77,3 796,79 88, 838,73 86,84 84,8 OriginalMembership QuarterlyAdultMembershipDataRefresh 36,48 3,7 3,4 3,868 3,844 39,99 4,48 47,99 433,9 RefreshOneQuarterLater 3,68 3,88 37, 33,99 38,7 43,66 49,3 437,987 4,7 AdultMembershipRefresh.6%.83%.77%.88% 7.4%.9%.63%.36%.3%

6 AdultMedicaidMembership MembershipbyBenefitGroup PG In HuskyD(MLIA)surpassedHUSKYAasthelargestbenefitgroupinmembership. SelectBenefitGroups MultipleValues TotalAdultMembershipbyBenefitGroup(8+) Grayverticallineindicatesthelastrefreshedquarter (Adult) 4K 3K Membership K K K ACAImplementation Q3 Q4 7,87 7,48 76,7 77,8 89,798 9,34,7 6, 9,88 6,7 HUSKYB , 979,4,4,4, 3,79 33,3 33,4 33,6 3,894 3,7 3,7 3,447 3,397 9,6 HUSKYC(LTCSingle),947,949,846,79,834,88,84,79,693,44 9,99 3,76 4,379 6,3 63,7 76,86 87,,679 6,463,939 (Adult) 3,8 37,74 39,36 33,99 386,49 4,4 4, ,987 4,7 449,3

7 AdultMedicaidMembership MembershipbyBenefitGroup PG 3 ProfileofMembership Thefolowinggraphandtablearetobeusedintandem toprovideinformationabouttheprofileofmembershipforthecurentreportingperiod.thecompositionof membershipgraphbelowdisplaysthevolumeofmembersbybenefitgroupfortheperiod,whichprovidescontexttothetabulationofadmits/,bybenefit groupandlevelofcare.thistableservesnotonlytocompareutilizationofonelevelofcarebybenefitgroup(verticalcomparison),butalsotocomparetheutilizationofallevelsofcareforeachbenefitgroup(horizontalcomparison). EachbenefitgroupusesOutpatientservicesthemostincomparisontootherlevelsofcare.Basedondataofthepreviousquarters,was thelargestbenefitgroupinadultmembership.in,becamethelargestbenefitgroupinadultmembership.inadditiontobeingthelargest benefitgroupinmembership,thepopulationusesthemostservicesofanybenefitgroup.hasthehighestadmits/,foreverylowerlevelofcareandforinpatientdetoxification:freestanding.thepopulationhasthegreatestutilizationoftheinpatientpsychiatric levelofcareandtheinpatientdetox:hospital-basedlevelofcareonanadmits/,basis. QuarterlyCompositionofAdultMembershipbyBenefitGroup ' SelectQuarter: 6,7 HUSKYB, 9,6 HUSKYC(LTCSingle),44,939 Outpatientservices continuestobethe mostutilizedlevel ofcareamongal benefitgroups. BenefitGroup IPF IPDH IPDF PHP IOP AMD MET OTP HUSKYB K K 4K 6K 8K K K 4K 6K 8K K K 4K Membership bylevelofcareforeachbenefitgroup ' SelectQuarter:

8 InpatientPsychiatricFacility PG 4 InpatientPsychiatricFacility-Adult(8+) ExcludingState-RunFacilities SelectBenefitGroup(s) MultipleValues ACAImplementation Q3 Q4 Overview Asidefrom thenoticeableincreaseinadmits/,and days/,inthepopulation,the coremeasuresofutilizationforinpatientpsychiatriccare haveremainedrelativelyunchangedinthefirsthalfof. Theadmits/,forAlBenefitGroupshaveremainedrelativelysteadyinthefirsthalfof.Theadmits/,rate forthepopulationhasbeenthe largestamongalthebenefitgroupsinthepastseveral quarters.forincreasedsteadilyfrom Q4 4to. TheInpatientPsychiatricadmits/,ratefortheHUSKYC (ABDSingle)populationhasbeen thelargestofalbenefitgroupsfor thelasttwoquarters. HUSKYA (FamilySingle) SelectIconfor VolumeGraph HUSKYC(ABD Single) ,64,4,,8,7,3,373,363,44,83 AlBenefits DualsRemoved.7,7.39,.4,47.,7.6,8.9,8.9,3.8,.8,4.,94

9 InpatientPsychiatricFacility PG InpatientPsychiatricFacility-Adult(8+) ExcludingState-RunFacilities SelectBenefitGroup(s) MultipleValues 6 BenefitGroup 4 3 Theresultsofdays/,datafolowthesametrends astheadmits/,data.inboththesemeasures,the upwardtrendinthepopulation in and isduetoslightincreasesinadmissionsaswelasatrendingdecreaseinmembership forthisbenefitgroup. ACAImplementation Q3 Q4 Cases Cases Cases Cases ,7 9.97, ,34 9., , , ,3 8., ,333 7., ,49 6., ,48.8, , , ,6.4, ,73.9,793

10 InpatientPsychiatricFacility AverageLengthofStay() PG 6 SelectBenefitGroup(s) MultipleValues InpatientPsychiatricFacility-Adult(8+) ExcludingState-RunFacilities BenefitGroup AverageLengthofStay() TheforAlBenefitGroupsdecreased slightlyinthefirsthalfof.historicaly,the foralbenefitgroupsishighestinthefirst quarteroftheyear.thiswasapaterninboth and.thedecreasesinobservedfrom to mayberelatedto thechangestothebypassprogram implemented inmarchof.thedecreaseinforthe populationwasstatisticalysignificantfrom to. Note:Alsignificancetestingresultsarelistedonpage ofthisreport. Avg.LengthofStay(#ofDays) ACAimplementation Q3 Q4 BenefitGroup HUSKYA (FamilySingle) Discharges HUSKYC(ABD Single) Discharges Discharges,48,46,6,3,34,3,36,373,44,9 AlBenefits DualsRemoved Discharges 8.99,4 8.6, , 8.9,68 8.8,7 8.8,74 8.6,3 8.7,67 8.7,39 7.8,3

11 InpatientPsychiatricFacility Summary PG 7 At7.8daysin',theaveragelengthofstayforInpatientPsychiatricwasthelowestrecorded. Conclusions Insummary,admits/,anddays/,remainedrelativelyunchangedforAlBenefitGroupsduringandof.measuresnowappear tohaveleveledofaftermembershipincreasedposttheimplementationoftheafordablecareact.anddays/,haveincreasedforhuskyc (ABDSingle).Themembershiphasdecreasedslightlyinthelastyears,andthenumberofadmissionshaveincreasedslightly(48admissionsinQ4 4,in,7in ),thusincreasingadmits/,anddays/,rates.however,theincreaseinadmits/,wasnotstatisticalysignificant. Thein wasthelowestrecordedat7.8days.theforeachbenefitgroupandalbenefitgroupsdecreasedfrom to.huskyc (ABDSingle)decreasedfrom 9.daysto8.89days.Thisisonlythesecondtimethatforthepopulationwasbelow9days. Thein was8.7days.thelongestlengthsofstayhavehistoricalybeenrecordedinofeachyearandaregreatlyinfluencedbytheofthe membershipgroup. InJuly,providersonbypassstatusbegansubmitinginitialandconcurentreviewsonlineviaBeacon sconnectsystem.inmarch,providerswere againevaluatedon,readmissionrates,anddischargecompletionrates.thoseprovidersthatmetcriteriaforbypasswereinformedoftheirstatus.regardlessofbypassstatus,alprovidersweretrainedandaskedtosubmitalreviewsonline.bypassprovidersaregiven7daysfortheinitialauthorizationandnon-bypassprovidersaregivenupto3daysfortheinitialauthorization.therewereseveralprovidersthatwereremovedfrom bypassduringthemostrecentevaluation period.thebypassincentivizesproviderstooferqualitycareintheshortesttimeframepossible.thedecreaseinmayhighlightsomeoftheeforts providersaremakingtoprovideeficientcaretomedicaidmembers.thebypassprovidersenjoythebenefitof bypassing concurentreviews.non-bypass providersseem tobemotivatedbythebenefitsofbypassstatusandsotheytooarecreatingeficiencieswhenpossible. Neitherthedaysmembersarewaitingforstatebeds,northedaysmembersspentonmedicalfloorsafectedtheduringandof. Recommendations.ContinuetheAdultInpatientBypassProgram -Determinationofbypassstatuswilbeconductedannualy,andmid-yearmonitoringwilbeconductedattheend of(eachyear). Update Providerswerenotifiedoftheirbypassstatusattheendofthefirstquarter.AltreatmentprovidersweretrainedonBeacon sstreamlinedreviewform in theconnectsystem.bypassandnon-bypassprovidersnowcompletealclinicalreviews(pre-certsandconcurent)on-line.onlybypassprovidersreceive7units fortheinitialauthorization.non-bypassprovidersreceiveupto3unitsfortheinitialauthorization.caremanagerscontinuetoofereducationtoproviderstoensure thatrequestsforinpatientcareincludesuficientclinicalinformationinordertomakelevelofcaredecisions.caremanagersarealsoavailabletoaidindischarge planningortreatmentplanningformemberswithcomplexneeds..continueadultparprogram Forhospitalswhosedatahasbeenstableoverthelongterm,itmaynotbenecessarytomeet,butdatawilbesharedelectronicaly.Forhospitalswhosedatahasbeeninconsistentorwheretrendsarenoted,meetingswilbescheduledinthecomingmonths. Update 'datahasbeensharedwithhospitalsandappropriatefolow-upmeetingshavebeenheld.rnmsareintheprocessofsetingupthenextroundof PARmeetingswithhospitalstaf.Athospitalsthathaveexperiencedrecentstafturnoverinkeypositions,RNMshaveheldmeetingstointroducethedashboard anddatameasurestonewstaf.inaddition,recognizingthematurityofthisprogram,rnmsareintheprocessofdevelopinganewstrategyforthisparprogram tosharpenitsfocusandprovidedatathatwilbemoreusefultohospitalstaf.wewilreportmorefulyonthenewstrategyinthenextreport.

12 InpatientDetoxification:Hospital-Based & PG 8 InpatientDetoxification:Hospital-Based-Adult(8+) ExcludingState-RunFacilities InpatientDetoxification:Hospital-Based-Adult(8+) ExcludingState-RunFacilities ACAImplementation ACAImplementation Q4 Q4 Q4 Q4 Overview TheimpacttotheutilizationmetricsofInpatientDetoxification:Hospital-Basedappearstohaveleveledof.Thelargeincreasesin admits/,anddays/,appeartobelessvariablefolowingbeacon sauthorizingoftheseservicesbeginningin 4. Theadmits/,forAlBenefitGroupsdecreasedslightlyinthefirsthalfof.Theadmits/,forincreasedinthefirsthalfof. Thedays/,ratesfolowthesametrendsastheadmits/,data. SelectBenefitGroup(s) MultipleValues

13 InpatientDetoxification:Hospital-Based &Tables Cases Cases Cases Cases InpatientDetoxification:Hospital-Based-Adult(8+) ExcludingState-RunFacilities InpatientDetoxification:Hospital-Based-Adult(8+) ExcludingState-RunFacilities PG 9

14 InpatientDetoxification:Hospital-Based AverageLengthofStay() PG 7 InpatientDetoxification:Hospital-Based-Adult(8+) ExcludingState-RunFacilities 6 SelectBenefitGroup(s) MultipleValues 4 3 AverageLengthofStay Afteranincreasingtrendinsince Q3 3,theforeachbenefitgroup hasgeneralydecreasedfrom Q4 4 through,thoughfor increased slightlyfrom to. ACAImplementation Q3 Q4 HUSKYA(Family Single) HUSKYC(ABD Single) AlBenefitsDuals Removed InpatientDetoxification:HospitalBased(IPDH)-&DischargeVolumeAdult(8+) ExcludingState-RunFacilities Discharges Discharges Discharges Discharges Theaveragelengthofstay formostbenefitgroupshas generalydecreasedfrom Q4'4through'.

15 InpatientDetoxification:Hospital-Based Summary PG Providerssuccessfulytransitionedfrom telephonictoweb-pendedauthorizationreviewsin. Conclusions Afterasignificantincreaseinadmits/,anddays/,in 4,soonafterBeaconbeganauthorizingdetoxesonmedicalfloors,thesemeasuresseem tobe stabilizing.therewereover6dischargesfrom InpatientDetoxification:Hospital-Basedfacilitiesduringeveryquarterpostthechangeinauthorizationprocesses from CHNtoBeacon.Thevolumeofreviewshasincreasedten-fold,promptingourefortstosupport/educatehospitalstafonlevelofcareandaidindischarge planning. TheforInpatientDetoxification:Hospital-Basedwas.38daysinand.daysin.Thewasslightlygreaterthan6daysintheprecedingtwo quarters.aspecializedchnco-managementteam continuestoworkwithprovidersandchntobeterunderstandtheneedsofthesemembersandplanaccordingly.yalenewhavenhospitalandst.francishospitalcontinuetoreceiveadditionalsupportincoordinatingcareformembersin InpatientDetoxification:Hospital-Based.APeerSpecialistandICM areassignedtoeachofthesehospitalsandworkstowardsengagingmembersandprovidersincareplanning.thegoalisto reducereadmissionsbyconnectingmemberstocareandsupportsinthecommunity. Recommendations.Transitionfrom telephonicpre-certificationtoweb-basedpre-certification Providerswillearnhowtosubmitreviewsandwillearnthedepthofclinicalinformationneededtomakelevelofcaredeterminations.Requestsforadmissionswilbestreamlinedandexpectationsclear.Asaresult,hospitalstafcanspendless timeonauthorizationsandmoretimeonpatientcare. Update InpatientDetoxification:Hospital-BasedrequestsarecurentlysubmitedonlineviaBeacon sproviderconnectsystem.trainingonproviderconnect wasconductedbyproviderrelationsduringmarchandapril.providerrelationsandclinicalstafwilcontinuetosupportproviderswhohavenotyettransitioned totheonlineprocessinlearninghowtonavigatetheconnectsystem.providerswilalsocontinuetobeeducatedonthedepthofclinicalinformationnecessaryfor levelofcaredetermination.providershavesuccessfulytransitionedtosubmitingclinicalreviewsinconnect.activitiesrelatedtothisrecommendationshavebeen completed..increasecommunicationandcolaborationwithhospital-baseddetoxificationproviders RNMsandClinicalSupervisorsplantorequestmeetingswithhospital providers.theinitialmeetingwilbeusedtoclarifyprocessesandprotocolsrelatedtodetoxauthorizationsandaftercareplanning.futuremeetingswiloferopportunitytopromoterealtimeum processcommunication,reviewandrapidreadmissiondata,deviseinnovativestrategiestoresolvebarierstodischarge, identifygapsinservicesandexpediteconnecttocareinitiatives.meetingatendeeswilincludebeaconrnm,clinicalmanager,inpatientdetoxification:hospital- Basedadministration,directtreatmentproviders,dischargeplanners,andutilizationreviewpersonnel(specifictoeachhospital). Update RNMsandClinicalSupervisorsarebeginningtoscheduleandatendmeetingswiththeInpatientDetoxification:Hospital-Basedunitsacrossthestate. Severalmeetingshavealreadyoccured(i.e.CharloteHungerford,St.Francis,andYale)withpositiveoutcomesrelatedtosharingandreadmissionrates from theadultdashboard.themeetingshavealsofocusedondevelopingstrategiestoimprovetheum processanddecreasebarierstodischarge.meetingswith otherinpatientdetoxification:hospital-basedprovidersareintheprocessofbeingscheduled.futuremeetingswilbeoferedatleasttwiceayearforon-going datareviewandcolaboration.

16 InpatientDetoxification:Freestanding & PG 6 InpatientDetoxification:Freestanding-Adult(8+) ExcludingState-RunFacilities InpatientDetoxification:Freestanding-Adult(8+) ExcludingState-RunFacilities 4 3 ACAImplementation Q4 Q4 ACAImplementation Q4 Q4 Overview ThecoremeasuresofutilizationforInpatientDetoxification:Freestandinghaveremainedrelativelyunchangedinthefirsthalfof,indicatingthatthereislitlechangeintheutilizationofcareinthepopulationordailyimpactonthebehavioralhealthcaresystem. Theadmits/,forAlBenefitGroupshaveremainedrelativelysteadyinthefirsthalfof.for haveleveledofafterthedeclinerelatedtonewmembershipin 4. SelectBenefitGroup(s) MultipleValues Theresultsofdays/,datafolowthesametrendsastheadmits/,data.

17 InpatientDetoxification:Freestanding &Tables.44,83.3,36.43,4.3,.,63.,68.3,484.,36.6,67.98, ,87 6.8,947.79,794.69,76 3.9, 4.3,8 4.7,4 4.33, , 3.47,96 InpatientDetoxification:Freestanding-Adult(8+) ExcludingState-RunFacilities Cases Cases Cases Cases 9.6, , ,3 9.3,9 8.4,76 8.8,78 8.4,8 8.8,47 8.8,779 8., , ,9.46,874.9,776.74, ,9 6.6, , ,334 4.,8 InpatientDetoxification:Freestanding-Adult(8+) ExcludingState-RunFacilities PG 3

18 InpatientDetoxification:Freestanding AverageLengthofStay() PG InpatientDetoxification:Freestanding-Adult(8+) ExcludingState-RunFacilities AverageLengthofStay Theremainedflatacrossal timeperiodsandbenefitgroups.protocoldrivendetoxregimensdrivethe lengthofstayatfree-standingfacilities. SelecttoView DischargeVolume Graph.... ACAImplementation Q3 Q4 HUSKYA(Family Single) HUSKYC(ABD Single) AlBenefitsDuals Removed InpatientDetoxification:Freestanding(IPDF)-&DischargeVolumeAdult(8+) ExcludingState-RunFacilities Discharges Discharges Discharges Discharges , , , , ,94 3.8, , , , , ,3 3.94, ,93 3.9, ,8 4., ,98 4.4, , ,676 SelectBenefitGroup(s) MultipleValues

19 InpatientDetoxification:Freestanding Summary PG Conclusions InpatientDetoxification:Freestandingisconsistentlyusedatthesecondhighestrate(OTPrateishigher)ofalservicesauthorizedbyBeaconfortheadultpopulation.memberscontinuetoutilizeInpatientDetoxification:Freestandingmost,whencomparedtoandHUSKYC(ABD Single).Therewere,676totaldischargesfrom freestandingprogramsin,accountedfor84% (,47)ofthesereporteddischarges. TheforAlBenefitGroupsin was4.4daysandin was3.98days.thislevelofcareremainsprotocoldrivenresultinginverylitlevariationin.severalprovidershaverecentlyadopteda-daybenzodiazepinetaperprotocol,andotherprovidershavebeenworkingcloselywithedstoadmitmemberswhohaveinthepastbeenadmitedtohospital-baseddetox;neitherfactorhasimpactedthe.thedashboardwilcontinuetobesharedbyrnmsso thatandreadmissionratescanbereviewed.ingeneral,providersseem morefocusedonreadmissionratesasaqualitymeasurethanon. Recommendations.ContinuetoCoordinatewithABH WewilcontinuetomeetmonthlywithDMHASandABHtoreviewOATPoutcomesanddevelopstrategiestoimproveoutcomes.Wewilcontinuetoholdabi-monthlyICM strategymeetingwithabhregionalmanagers(andbeaconicms)toensurethattransitionswithinthesubstance abusecontinuum foroursharedmembersaresmoothandtimely.theoverarchingpurposeofthisstrategymeetingistoimproveoutcomesforoursharedmembersthroughcoordination,communication,andintervention. Update ThelaststrategymeetingwasheldonApril9,atABH.Thethreemainareasofdiscussionwere:atendanceandinformationsharingatCCTs acrossthestate,workingwithproviderstoensurerehabisaccessibleandrehabsthattreatspecialpopulations.ournextabh/beaconstrategymeetingisscheduledforseptember6,.inpatientdetoxandreadmissionrateswilbereviewed.activitiesrelatedtothisrecommendationareongoingandaprogress updatewilbedescribedinthenextreport.

20 HomeHealthServices Theadmits/,foreachbenefitgrouphasremained steadyinthefirsthalfof. Q3 Q HomeHealthServices:SkiledNursing-Adult(8+) BenefitGroup HUSKYC(ABDDual) SelectBenefitGroup MainGroupstoVieware: HuskyC(ABDDual),HuskyC(ABDSingle),HuskyD(MLIA) MultipleValues HUSKYA(FamilyDual) HUSKYB HUSKYC(ABDDual) HUSKYC(LTCDual) HUSKYC(LTCSingle) AlBenefitsWithDuals HomeHealthServices:SkiledNursing(SNV)-&Adult(8+) PG 6

21 HomeHealthServices MedicationAdministration&Utilization(ED/IPF/OBS) PG 7 K 4K MedicationAdministrationVolume Statewidevs. PARProviders PARProviderEmergencyDepartment,InpatientHospitalizationand3- HourObservationBedUtilizationRates 3% EDRate IPRate OBSRate Volume 3K K % K K Q3 Q3 PARProviderMedicationAdministrationQDvs.BIDRates QDRate BIDRate(thickline) % ofmemberswith+visits/episodes % % 3% % Rate % % % % Q3 Q3 % Q3 Q3 Note:PARProvidersarethoseagenciesinvolvedinourProviderAnalysisandReporting (PAR)Program,whichisbasedonutilizationvolume.Tablesforthefolowinggraphscanbe foundseparatelyonthenextpageandthemeasuresonthispagearebasedofclaimsand thereforehavealag.thelastreportedquarteris'4.

22 HomeHealthServices MedicationAdministration&Utilization(ED/IPF/OBS)ReferenceTables PG 8 MedicationAdministrationVolume Statewidevs.PARProviders Q4 PARProvider 4,88 4,8 4,76 4,3 4,4 4,37 4,39 4,6 4,96 4,34 4,37 Statewide 4,74 4,833 4,8 4,883 4,79 4,886 4,9 4,897,,6,39 PARProviderMedicationAdministrationQDvs.BIDRates Q4 BIDRate.9%.%.9%.%.% 9.8% 9.4% 8.9% 9.6% 9.% 9.8% QDRate 3.7% 33.% 34.% 33.% 3.8% 33.3% 3.% 33.% 33.7% 3.% 33.% PARProviderEmergencyDepartment,InpatientHospitalizationand3HourObservationBedUtilizationRates Q4 EDRate IPRate OBSRate

23 HomeHealthServices Summary PG 9 Conclusions tohomehealthdecreasedby.4% (667to63)from Q4'4to'.Themajorityofadmits/,toHomeHealtharetheHUSKYC(ABDSingle anddual)members,folowedbymembers.thestatewidevolumeofmembersreceivingmedicationadministrationhasincreased.4% from Q4 '3to'4.ThepercentofPARProvidermembersreceivingBIDmedicationadministrationhasdecreasedoverthepastthreeyearsandthedailymedication administrationhasremainedfairlystableacrossalmeasuredquarters. ThereductioninBIDservicesoveralhasnotresultedinanysignificantchangeintheinpatientoremergencydepartmentrates,astheyhaveremainedfairlyconstant.Therecontinuestobeslightincreasesintheobservationrateoverthelastfivequarters.Thisresultmostlikelyrelatestoanoveralincreaseintheuseofobservationbedsbyalhospitals.Wewilcontinuetomonitorthistrend. Recommendations.Continueplannedfocusonclaimsdataanalysis. Beaconwilcontinuetoprovideanalysisoftherelationshipbetweenreductioninmedicationadministration frequency,re-hospitalizationrates,andconnectiontoothercommunityservicesformemberstoensurethatfurtherreductionsinmedicationadmininstrationfrequencyarenotcausinganincreaseinutilizationofthoseotherservices.wewilcontinuecohorttrackingofmembersreceivingbidmedicationadmininstration servicetorefineourknowledgeandunderstandingofutilizationpaterns.wewilcontinuetoengageprovidersinexplorationofthevariancesinfrequencyreductionratesandhospitalization/obsandedratesthroughsemiannualgroupandindividualparmeetingswiththe3parproviders. Update InadditiontothePARprovidermeetingsthatareheldregularlytoreviewproviders dataprofiles,beaconhascontinuedtoanalyzetheutilizationpatternsofmembersreceivingbidmedicationadmininstrationtoidentifycharacteristicsorpaternsofchronicfrequencyvs.stabilizationeforts.beaconcontinuesto meetwiththeparprovidersforclarificationofoperationalprocesses,suchasuseofnursedelegation,medicationdispensingmachines,andhhaprompting..implementbypassprogram forhomehealthagencies ThereareopportunitiesforHomeHealthagenciestofocusefortsonpromotingmemberindependence,recoveryandresiliency.ReducingthedependenceofBIDmedicationadministrationisonesuchefort. Update BeaconisintheprocessofworkingwithHomeHealthagenciestodevelopcriteriaforabypassprogram.Thebenefitsofabypassprogram arethatit providesadministrativereliefforbothctbhpandhomehealthagencies.theproposedbypasseligibilitycriteriawilincludeachievementofametricevidencinga reductioninthepercentageofmembersperagencyreceivingbidmedicationadministration.thisisachievedbyauthorizingcareforlongerperiodsoftimefor thoseagenciesmeetingthisreduction,thusdecreasingthenumberofconcurentreviewsrequiredforanepisodeofcare. 3.IncreasedColaborationwithCHN TopromotetheeficientandappropriateuseofHomeHealthservices,itisnecessaryfortherespectiveAdministrativeServiceOrganizationstocolaborateonStateinitiativesandgoals. Update Beaconhasmetwithleadershipfrom CHNtodiscussHomeHealthauthorizations,levelofcareguidelinesandcasestodevelopparaleleficienciesin operationalprocess,communicationandcriteriaforhomehealthservices.beaconmetwithchnandthedepartmentofsocialservicestodiscusstheseeforts, data,andrecommendationstoachieveeficientutilizationofhomehealthmedicationadmininstration. Recommendationscontinuedonthenextpage.

24 HomeHealthServices,continued Summary PG Recommendations,continued 4.DiscussandreviewHomeHealthagencyPARdataandreviewerfindings,withafocusonproviderswhosefrequencyofvisitshasincreasedorremainsabove thestatewideaverage. Update Thoseproviderswhosefrequencyofvisitshasincreasedorremainsabovethestatewideaveragearebeingreviewedininternalcaseroundswiththe MedicalDirector.ThisprocesshasbeenincorporatedintoourclinicalprocessandwilcontinueasweworkwithHomeHealthagenciestodevelopabypassprogram..Institutehomehealthdischargeroundstoreviewcasesopenlongerthanninemonthsandidentifypotentialdischargeplanningactivitiesforproviders. Opportunityexistsforincreaseddialogueofalternativeplansformemberswhoareeithercapableofself-administration,orforwhom lesscostlyand/orlessrestrictiveoptionsmayexist. Update Beaconhaspreviouslyrestructuredtheutilizationmanagementprocess,whichincludedcriteriaofcasereviewandconsultwiththeMD.AdditionalclinicalroundswiththeMedicalDirectorhavebeenimplemented.Thisincreaseddialoguehasofteninvolveddirectcommunicationfrom thebeaconmedicaldirector withthephysicianswhoarerequesting/orderingservicesfrom ahomehealthagency.thishasbeenabeneficialpracticetoclarifyclinicalycomplexcasesand utilizationquestions.beaconwilcontinuetoactivelycommunicatewiththeorderingphysicianinadditiontoefortstoidentifyopportunitiesforimprovementinutilizationmanagement. 6.WorkwiththeDepartmentofSocialServicestoimplementHomeHealthAidemedicationprompting.Utilizationofcertifiedhomehealthaidestoperform medicationpromptingforacohortofhuskymembershasthepotentialtobeaneficientprocesstoreduceoverdependenceonskilednursingforthesolepurposeof medicationadministration. Update Beaconcontinuestorecommendtheuseofhomehealthaidepromptingforthesolepurposeofmedicationadministrationvisitstoreducethedependenceofskilednursingmedicationadministrationutilization.BeaconhasmetwiththeDepartmentofSocialServicesandCommunityHealthNetworkASO todeveloprecommendationsandcriteriaforthispotentialadditionalserviceandcontinuestoprovidethemedicationassistedtraining(mat)tohomehealthagencies andresidentialcarehomes.thegoalofthematprogram istotraincertifiedhomehealthaidesinmedicationparameterstodevelopaknowledgeableandsafe workforcethatcomplimentsandsupportstheskilsofregisteredprofessionalnurses.

25 GlobalRecommendationsandUpdates PG.SupportRegionsinthedevelopmentofCommunityCareTeam (CCT)Meetings RNMswilcontinuetosupporteachregion/hospitalintheplanninganddevelopmentphaseandICMswilparticipateinfolow-upmeetings. Update ContinuetosupportCCTspendinginformationfrom DMHASregardingthegrantapplicationprocessforthehospitals,withgoaloftransitionofCCTsto hospitalswhengrantsareawarded..increasecoordinationwithchn Clinicalmanagers/administratorsfrom CHNandBeaconmeetbi-weeklytoreviewprotocolsandproceduresrelatedtoauthorizationsandsharedcases.Aswemovetowardsanintegratedhealthmodelwewilfurtherdevelopcommunicationplansandmemberspecificinterventions thatreflectoursharedefortstoprovidequalitycareandsupportformedicaidmembers. Update Clinicalmanagementfrom BeaconHealthOptionsandCHNcontinuetomeetonabi-weeklybasistoensurealworkflowsareaccurateandareimplementedconsistently.BeaconandCHNcontinuetorefercasesdailyforco-managementactivitiesandoutreachtofacilitiestosupportdischargeplanningneeds. BeaconandCHNhavebegundiscussionsabouthowtopartnerandworkwithintheco-managementmodeltoaddressthechronicpainmanagementpopulation. 3.Developacomprehensivein-statecontinuum ofcareformemberswitheatingdisorders Therearetwointermediatecareprovidersin-stateandseveraloutpatientprovidersthatservethispopulation.Inpatientcarethatspecificalyfocusesonboththemedicalandpsychiatricefects/symptomsoftheeatingdisorderare onlyavailableoutofstate.continuityandcoordinationofcarecanbechalengingwhentherearelimitedprovidersoveralandproviderstreatingmembersinone levelofcareareunfamiliarwithproviderstreatingmembersinlower/higherlevelsofcare.memberswitheatingdisordersneedaccesstoavarietyofserviceswithincttoensurethatcareiscomprehensiveandwel-coordinated. Update Baseduponadultpsychiatrichospitalproviderfeedbackgatheredfrom recentparmeetingsthemajorityofprovidersreportedthatmemberswitheating disordersarerarelytreatedonthepsychiatricunit.themajorityofthesepatientsaretreatedonmedicalunits.severalhospitalsreportedalackofhospitalresources,spaceandspecializedstafingasbariersinoferingservicesformemberswitheatingdisorders.onehospital,rockvilegeneralhospitalplanstoopena -bedinpatientprogram formemberswitheatingdisordersbyoctober.thisresourcewilbeawelcomeadditiontothein-stateprogrammingformembers witheatingdisorders.conversationsregardingcapacityandcapabilitiestotreatmemberswitheatingdisorderswilcontinue. 4.EstablishanASO BehavioralHealthSystemsCommitee(ABH/DMHAS)wherebysystemsofcare(e.g.residentialrehab)thatfaloutsidethescopeofBeacon s existingprovidernetworkofcareworktogethertoidentify,problem solve,andaddresssystemicbariers.severalconnecttocaremeetingshavebeenheldinthe NewHavenareatodiscusscoordinationamongstinpatientproviders(IPDandIPF)andstatewideresidentialrehabilitationprograms.Thefolowingrecommendationsforimprovedaccesswereidentified: a.examineresidentialrehabilitationlevelofcarecapacitytoadequatelyservethreedistinctpopulationsidentified)sa,)co-occuring,3)co-morbid b.examineutilizationofdmhasrecoveryhouses(e.g.stepupversusstepdown) c.examinethepotentialofdevelopingastandardizedreferalform andcentralizedaccess Update BeaconHealthOptionsisworkingwithStatePartnerstofurtherassessgapsinthesubstanceusetreatmentcontinuum.

26 Appendix MentalHealthGroupHome Q4 Q4.. AlAdultbyBenefitGroup(8+) Q4 Q4 4 6 Avg.LengthofStay MentalHealthGroupHomeAdultbyBenefitGroup(8+) Q4 Q4 4 6 AlAdultbyBenefitGroup(8+) BenefitGroup HUSKYC(ABDDual) Cases Discharges Cases Discharges HUSKYC(ABDDual) Cases Discharges Cases Discharges PG

27 Appendix PHP,IOP,MethadoneMaintenance,AmbulatoryDetoxification&Outpatient Q3 Q ACAImplementation PHPbyBenefitGroup(8+) HUSKYB HUSKYC(LTCSingle) ,4.83, ,3.77 SelectaLevelofCaretoViewGraphandTableDetails: SelectaLevelofCare PHP BenefitGroup PG 3

28 Appendix PHP,IOP,MethadoneMaintenance,AmbulatoryDetoxification&Outpatient Q3 Q ACAImplementation IOPbyBenefitGroup(8+) HUSKYB HUSKYC(LTCSingle) ,6 8.3,73 8.7,47 7.8, ,9. 3,38.68,9.8, ,. 3, , , , , , , , , , , SelectaLevelofCaretoViewGraphandTableDetails: SelectaLevelofCare IOP BenefitGroup PG 3

29 Appendix PHP,IOP,MethadoneMaintenance,AmbulatoryDetoxification&Outpatient Q3 Q ACAImplementation MethadoneMaintenancebyBenefitGroup(8+) HUSKYB HUSKYC(LTCSingle) ,.8,.,3.99,39.6,.64,4.68,3.,77.6,6.6,7.,33.7,478.,96.,4.3,36.,3. SelectaLevelofCaretoViewGraphandTableDetails: SelectaLevelofCare MethadoneMaintenance BenefitGroup PG 3

30 MethadoneMaintenanceRecommendations PG 4 Recommendations.Identifymemberswhocanbenefitfrom servicesclosertotheirresidence.logisticareissendingtransportationrequestsformemberswithcomplexneedsand whoaretravelingmorethanmilesformethadonemaintenancetobeacon sclinicalstafforclinicalreviewandrecommendations.stafwilproactivelyoutreach toproviderstoassistintransferingmemberstoclosestmethadoneprovidersothattreatmentisnotinterupted.whentransferingtoacloserclinicisnotfeasible, alternativemodesoftransportationareexploredand/orprovidersareaskediftakehomedosescanbeconsidered. Update-Beaconhassuccessfulytransitionedmemberstoclosermethadonemaintenanceprovidersbyworkingcloselywithmethadoneproviderstoovercome identifiedbariers,arangeintakeappointments,andarangenewtransportationviacolaborationwithlogisticare.additionaly,beaconhasreceivedapproximatelyreferalsfrom Logisticare.MonthlymeetingswithLogisticareareheldtoevaluateandamendthereferalprocessasnecessary.Beaconhassuccessfuly helpedmanymemberstransfertocloserprovidersaswelasdecreasingfrequencyofliveryservices(byincreasingtakehomesorreplacingliveryserviceswith masstransitorgasreimbursementbenefits).providingclosetohome,uninteruptedcareformemberswithmedicaidisthegoalofthisproject.activitiesrelatedto thisrecommendationareongoing.

31 Appendix PHP,IOP,MethadoneMaintenance,AmbulatoryDetoxification&Outpatient Q3 Q ACAImplementation AmbulatoryDetoxificationbyBenefitGroup(8+) HUSKYB HUSKYC(LTCSingle) SelectaLevelofCaretoViewGraphandTableDetails: SelectaLevelofCare AmbulatoryDetoxification BenefitGroup PG 3

32 Appendix PHP,IOP,MethadoneMaintenance,AmbulatoryDetoxification&Outpatient Q3 Q4 ACAImplementation OutpatientbyBenefitGroup(8+) HUSKYB HUSKYC(LTCSingle), ,88. 6,4.7 6,6.9 6, ,97. 6,83. 6,737. 7,4.47 7, , ,87 9., , ,73 9.9, ,89.,63 7.8,8.9, ,9. 8,67.9 8, ,73 7.,68.67,39 3.9,33.,9 3. 3,3.63,37., , , , ,34 6.8, , ,79 7.3, , SelectaLevelofCaretoViewGraphandTableDetails: SelectaLevelofCare Outpatient BenefitGroup PG 3

33 QuarterlyAdultChi-SquaredSignificanceTestingResults PG SignificanceTestingforQuarterlyComparisonsofAdmissionVolumeforInpatient(IPF),InpatientDetoxification:Hospital-Based(IPDH),&InpatientDetoxification:Freestanding(IPDF) Red"X"IndicatestheComparisonwasStatisticalySignificant LOC BenefitGroup '4to' 'to' '4to' Q4'4to' IPF HUSKYB LevelofCare Al SignificantorNot Al BenefitGroup Al SignificantorNot NotSignificant Significant HUSKYC(LTCSingle) IPDH HUSKYB HUSKYC(LTCSingle) IPDF HUSKYB HUSKYC(LTCSingle)